How “bad” does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis

Authors

  • Joanna E. M. Sale,

    Corresponding author
    1. Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
    • Canadian Osteoarthritis Research Program, Women's College Ambulatory Care Center, Sunnybrook & Women's College Health Sciences Centre, 76 Grenville Street, Room 812B, Toronto, Ontario, Canada M5S 1B2
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  • Monique Gignac,

    1. The University Health Network & Department of Public Health Sciences, The University of Toronto, Toronto, Ontario, Canada
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  • Gillian Hawker

    1. Sunnybrook & Women's College Health Sciences Centre, Ontario, Canada
    2. The University of Toronto, Toronto, Ontario, Canada
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Abstract

Objective

To explore the experience of adherence to pain medication in older adults with osteoarthritis (OA).

Methods

Individuals were recruited from an existing cohort (n = 1,300) of persons with disabling hip and knee OA. Twenty-seven individuals who reported previous physician visits for their arthritis, spoke English, were Toronto residents, and were receptive to in-depth interviews were approached by the cohort telephone interviewer to discuss their experiences with prescribed painkillers for OA. Semistructured face-to-face interviews were conducted by a qualitative researcher in participants' homes.

Results

Nineteen adults (10 women, 9 men) ages 67–92 years were interviewed for 1–3 hours. Participants varied in their socioeconomic status and education levels. Most had comorbidities, such as heart disease and diabetes, for which they were also being treated. Findings indicated that adherence to pain medication differed from that of other prescribed medications. Participants were reluctant to take painkillers, and when they did, they generally took them at a lower dose or frequency than prescribed. This behavior did not reflect their recommendations for others, who they expected to be treated appropriately for pain and to adhere to pain medication. Perceptions and attitudes to pain played an integral role in participants' adherence to painkillers. Despite obvious physical limitations, participants minimized their pain and claimed to have a high pain tolerance.

Conclusion

These findings suggest that reevaluation of the prescription of pain medication for OA is warranted and that the effectiveness of pain management in OA needs to account for adherence behavior in older adults.

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